POS0613 IDENTIFICATION OF PREDICTORS OF SUDDEN CARDIAC DEATH IN PATIENTS WITH RHEUMATOID ARTHRITIS
Authors: L. Feiskhanova, D. Abdulganieva
Journal: Annals of the Rheumatic Diseases (2022)

Background Rheumatoid arthritis (RA) is a systemic autoimmune disease with a high cardiovascular risk, increasing the incidence of coronary artery disease, ventricular arrhythmias and sudden cardiac death (SCD). The annual incidence of SCD among the general population is 0.2%, and patients with RA are twice as likely to develop it as healthy people. The well-known predictors of the development of SCD are the variance of the QT interval and the alternation of the T-wave. Objectives to study the prevalence of predictors of the risk of SCD among patients with RA. Methods 282 patients with verified RA were examined, including 240 women and 42 men. All patients underwent standard laboratory and instrumental diagnostic tests. In addition, electrocardiography was performed with the calculation of the QT interval variance and determination of the T-wave alternation, two-dimensional transthoracic echocardiography with tissue Dopplerography of the myocardium. Results The echocardiography allowed us to identify patients with diastolic dysfunction and form the following groups. 1 group – with normal heart geometry and without diastolic myocardial dysfunction (91 patients), 2 – with normal heart geometry and with diastolic dysfunction (45 pts), 3 - with structural and geometric remodeling of the heart and without diastolic myocardial dysfunction (73 pts), 4 – with structural -geometric remodeling of the heart and with diastolic dysfunction (73 pts). Both groups of patients with rheumatoid arthritis, who had remodeling of the heart, practically did not differ in age. But in the group with diastolic dysfunction, a high variance of the QT interval was significantly more often detected than among individuals without myocardial dysfunction, 54.8 and 38.4%, respectively (p&lt;0.05). Thus, the development of diastolic dysfunction with altered heart geometry is more often accompanied by an increase in the variance of the QT interval, which is a predictor of sudden death in people with heart failure. In this regard, we conducted a comparison between individuals with a high variance of the QT interval (1st subgroup - 139 people) and without it (2nd subgroup - 143 people). We did not obtain significant differences between the subgroups in the prevalence of structural and geometric myocardial remodeling (51.8% and 51.7%, respectively), left ventricular hypertrophy (40.3% and 42.7%, respectively) and diastolic dysfunction (45.3% and 38.5%, respectively). However, in the subgroup with high QT interval variance, T wave alternation was more often recorded: 55.6% and 29.3%, respectively (p=0.0001). Conclusion The presence of diastolic dysfunction in patients with cardiac remodeling on the background of rheumatoid arthritis is accompanied by an increase in the variance of the QT interval, which, in turn, is associated with a more frequent occurrence of T-wave alternation. Therefore, patients with diastolic dysfunction and myocardial remodeling on the background of RA belong to the category of increased risk of SCD. References [1]Pascual-Figal DA, Ordoñez-Llanos J, Tornel PL et al. Soluble ST2 for predicting sudden cardiac death in patients with chronic heart failure and left ventricular systolic dysfunction. J Am Coll Cardiol. 2009 Dec 1;54(23):2174-9. doi: 10.1016/j.jacc.2009.07.041. [2]Merchant F.M., Sayadi O., Moazzami K. et al. T-wave alternans as an arrhythmic risk stratifier: State of the art. Curr. Cardiol. Rep. 15, 398 (2013). doi.org/10.1007/s11886-013-0398-7. [3]Masoud S. et al. Sudden cardiac death in patients with rheumatoid arthritis. World J. Cardiol. 2017; 9(7): 562-573. doi: 10.4330/wjc.v9.i7.562. Disclosure of Interests None declared